Burden on relatives of people with psychic disorder: levels and associated factors

Background Studies have shown that overburden with care of psychotic patients is associated with a significant reduction of quality of life and causes harm to the caregiver’s health. Objective In order to compare factors associated with levels of burden of caregivers with the psychopathology of the patient, we conducted a cross-sectional study with 435 primary caregivers of patients of Centers for Psychosocial Care (CAPS) from Pelotas, RS. Methods The patients were identified through medical records and their caregivers were interviewed in their homes. To evaluate the burden we used Zarit Burden Interview (ZBI). Results Caregivers of dependent users of alcohol and drugs had the highest average of burden, 52.2 points (sd = 20.4), followed by the caregivers of patients with suicide risk, 48.5 points (sd = 0.7). In adjusted analysis, women had 8.2 (95% CI: 4.6, 11.8) points higher on average than men in ZBI scale. Caregivers with less education had 1.6 (95% CI: -3.1, -1.0) points lower on average of burden compared to those with higher educational level. Caregivers with some health problem had 6.7 (95% CI: 3.3, 10.0) points higher in the middle of the ZBI when compared to those without disease. Discussion Several factors overload clearly indicate the need to develop interventions such as psychoeducation which may give some support to the family responsible for care.Contexto Estudos têm mostrado que a sobrecarga gerada no cuidado de pacientes psicóticos está associada com uma redução importante na qualidade de vida, trazendo danos à saúde do cuidador. Objetivo Com objetivo de verificar fatores associados e comparar níveis de sobrecarga de cuidadores com a psicopatologia do paciente, foi realizado um estudo transversal com 435 cuidadores principais de usuários de Centros de Atenção Psicossocial (CAPS) da cidade de Pelotas, RS. Métodos Os usuários foram identificados por meio de prontuários e seus familiares foram entrevistados posteriormente em suas residências. Para avaliar a sobrecarga, foi utilizada a Zarit Burden Interview (ZBI). Resultados Cuidadores de usuários dependentes de álcool e drogas apresentaram as médias mais altas de sobrecarga, 52,2 pontos (dp = 20,4), seguidos dos cuidadores com risco de suicídio, 48,5 pontos (dp = 0,7). Na análise ajustada, mulheres tiveram 8,2 (IC 95%: 4,6, 11,8) pontos a mais na média do ZBI do que os homens. Cuidadores com menor escolaridade apresentaram 1,6 (IC 95%: -3,1, -1,0) pontos a menos na média de sobrecarga comparados aos com maior grau de instrução. Cuidadores com algum problema de saúde tiveram 6,7 (IC 95%: 3,3, 10,0) pontos a mais na média do ZBI comparado àqueles sem nenhuma doença. Conclusões Vários fatores de sobrecarga indicam claramente a necessidade de se desenvolverem intervenções, como a psicoeducação, que possam dar algum tipo de apoio ao familiar responsável pelo cuidado

Efectos de la estimulación de corriente continua transcraneal (tDCS) sobre las citoquinas pro-inflamatorias : una revisión sistemática

Transcranial direct current stimulation (tDCS) is a neuromodulation technique that causes alterations in the synthesis of several proteins, including cytokines (e.g.,Interleukins). Pro-inflammatory cytokines are associated with the presence of pain and their reduction occurs in several pathologies. The aim of this study was to investigate the effects of tDCS on the variation of tissue and serum blood levelsof pro-inflammatory cytokines and its relationship with behavioral changes, through a systematic review. PubMed, Embase and Lilacs database searches were performed for articles published in all languages before October 1, 2020. The search was based on the keywords "Transcranial Direct Current Stimulation" or "tDCS" and "IL-1alpha " or "IL-1Beta" or "IL-6" or "IL-8" or "IL-17" or "Tumoralnecrosis factor alpha" or "TNF-alpha". The systematic review protocol was registered in PROSPERO (CRD42021283417). Initially, 416 studies were identified in the electronic databases, of which 40 were eliminated because they were duplicates. Of the remaining 376, 358 were excluded after analyzing the title and abstract (selection stage) and 09 were excluded after a complete reading. Nine studies were considered for evaluation. The results demonstrate that tDCS can alter the levels of pro-inflammatory cytokines and modify behaviors in animals, however these findings are variable.Still, the cause and effect relationship between cytokine levels and behavioral changes found was not conclusive. Further studies are needed to establish the mechanisms involved in the action of tDCS on the levels of pro-inflammatory cytokines.A estimulação transcraniana por corrente contínua (ETCC) é uma técnica de neuromodulaçãoqueinduzalterações na síntese de várias proteinas, incluindo as citocinas (ex. interleucinas). As citocinaspró-inflamatórias, estãoassociadasà presença de dor,e aalteração dos seus níveisocorreem diversas patologias. O objetivo desse estudo foi investigar os efeitos da ETCC na variação dos níveis teciduais e sanguíneos de citocinaspró-inflamatórias esua relação comalterações comportamentais, atravésde uma revisão sistemática. Foram realizadas buscas nasbases de dados PubMed, Embase e Lilacs para artigos publicados em todos os idiomas antes de 1º de outubro de 2020. A busca foi baseada nas palavras-chave "Transcranial Direct Current Stimulation" ou “tDCS”e "IL-1alpha" ou "IL-1Beta" ou "IL-6" ou "IL-8" ou "IL-17" ou "Tumoral necrosis factor alpha" ou "TNF-alpha".O protocolo de revisão sistemática foi registrado no PROSPERO (CRD42021283417).Foram identificados 416 estudos nas bases de dados eletrônicas, 40 foram eliminados por serem duplicados. Dos 376 restantes, 358 foram excluídos após análise do título e do resumo (etapa de seleção) e outros 09 após a leitura completa.Desta forma, nove estudosforam considerados para avaliação.Os resultados sugeremque aETCCpode alteraros níveis de citocinaspró-inflamatóriase modificarcomportamentosem animais, no entanto estes achados são variáveis.Ainda, arelação de causae efeito entreos níveis decitocinas e as alterações comportamentaisencontradasnão foram conclusivas. Novos estudos são necessários para que sejam estabelecidosos mecanismos envolvidos naação da ETCCsobre os niveis decitocinas pró-inflamatórias.La estimulación con corriente continua transcraneal (tDCS) es una técnica de neuromodulación que provoca alteraciones en la síntesis de varias proteínas, incluidas las citocinas (por ejemplo, las interleucinas). Las citocinas proinflamatorias se asocian con la presencia de dolor y su reducción ocurre en diversas patologías. El objetivo de este estudio fue investigar los efectos de tDCS en la variación de los niveles tisulares y sanguíneos de citocinas proinflamatorias y su relación con los cambios de comportamiento, a través de una revisión sistemática. Se realizaron búsquedas en las bases de datos PubMed, Embase y Lilacs de artículos publicados en todos los idiomas antes del 1 de octubre de 2020. La búsqueda se basó en las palabras clave "Transcranial Direct Current Stimulation" o "tDCS" y "IL-1alpha" o "IL-1Beta" o "IL-6" o "IL-8" o "IL-17" o "ou\"Tumoral necrosis factor alpha" o "TNF-alpha". El protocolo de revisión sistemática se registró en PROSPERO (CRD42021283417). Inicialmente se identificaron 416 estudios en las bases de datoselectrónicas, de los cuales 40 fueron eliminados por estar duplicados. De los 376 restantes, 358 fueron excluidos después del análisis del título y el resumen (etapa de selección) y 09 fueron excluidos después de la lectura completa. Nueve estudios fueronconsiderados para evaluación. Los resultados demuestran que tDCS puede alterar los niveles de citoquinas proinflamatorias y modificar comportamientos en animales, sin embargo, estos hallazgos son variables. Aún así, la relación de causa y efecto entre losniveles de citoquinas y los cambios de comportamiento encontrados no fue concluyente. Se necesitan más estudios para establecer los mecanismos implicados en la acción de tDCS sobre los niveles de citocinas proinflamatorias

Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil

Background Breastfeeding has clear short-term benefi ts, but its long-term consequences on human capital are yet to be established. We aimed to assess whether breastfeeding duration was associated with intelligence quotient (IQ), years of schooling, and income at the age of 30 years, in a setting where no strong social patterning of breastfeeding exists. Methods A prospective, population-based birth cohort study of neonates was launched in 1982 in Pelotas, Brazil. Information about breastfeeding was recorded in early childhood. At 30 years of age, we studied the IQ (Wechsler Adult Intelligence Scale, 3rd version), educational attainment, and income of the participants. For the analyses, we used multiple linear regression with adjustment for ten confounding variables and the G-formula. Findings From June 4, 2012, to Feb 28, 2013, of the 5914 neonates enrolled, information about IQ and breastfeeding duration was available for 3493 participants. In the crude and adjusted analyses, the durations of total breastfeeding and predominant breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with IQ, educational attainment, and income. We identifi ed dose-response associations with breastfeeding duration for IQ and educational attainment. In the confounder-adjusted analysis, participants who were breastfed for 12 months or more had higher IQ scores (diff erence of 3·76 points, 95% CI 2·20–5·33), more years of education (0·91 years, 0·42–1·40), and higher monthly incomes (341·0 Brazilian reals, 93·8–588·3) than did those who were breastfed for less than 1 month. The results of our mediation analysis suggested that IQ was responsible for 72% of the eff ect on income. Interpretation Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important eff ect in real life, by increasing educational attainment and income in adulthood

Violência urbana em Novo Hamburgo: notas introdutórias

This article discusses the importance that violence is acquiring at all levels of society. Nowadays, the subject “violence” is accepted as a result of a process that determines both culture and the economic, social and political values. The article investigates data about the state of Rio Grande do Sul and the municipality of Novo Hamburgo. The latter was the 4th most violent municipality in Rio Grande do Sul in 2004 as far as the homicide rate is concerned. The data lead to the conclusion that in such a context civil society is insecure and afraid of violence. They also show the importance of promoting public policies. Keywords: urban violence, homicide, security, public policies.O presente artigo trata da violência que assume um papel preponderante em todos os níveis da sociedade. Atualmente o tema violência vem sendo aceito como resultado de um processo que condiciona tanto a cultura como os valores sociais, econômicos e políticos. Para isso, investigam-se os dados do Rio Grande do Sul e de Novo Hamburgo, município que se caracteriza como quarto mais violento em taxas de homicídio, em 2004, do estado gaúcho. Os dados levam à conclusão de que a sociedade civil inserida nesta condição vive com insegurança e medo, e a análise esboçada aponta a importância de promover políticas públicas. Palavras-chave: violência urbana, homicídio, segurança, políticas públicas

Associação entre abuso de álcool durante a gestação e o peso ao nascer

OBJECTIVE: To assess the association between alcohol abuse during gestation and low birth weight. METHODS: Cross-sectional, population-based nested study from a cohort of 957 pregnant women who received prenatal assistance through Sistema Único de Saúde (National Health System) in the city of Pelotas, Southern Brazil, and delivered their babies between September 2007 and September 2008. The mothers were interviewed at two distinct moments: prenatal and postpartum periods. In order to verify alcohol abuse, the CAGE (Cut down, Annoyed by criticism, Guilty and Eye-opener) scale was used. Bivariate analyses were carried out, as well as multiple logistic regression adjusted by the variables prematurity and alcohol abuse. The level of significance that was adopted was 95%. RESULTS: Of the women who participated in the study, 2.1% abused alcohol during pregnancy and, among these, 26.3% had low birth weight children. There was an association between alcohol abuse and low birth weight (pOBJETIVO: Verificar la asociación entre abuso de alcohol durante la gestación y bajo peso al nacer. MÉTODOS: Estudio transversal de base poblacional anidado a una cohorte de 957 gestantes que realizaron acompañamiento prenatal en el Sistema Único de Salud de la ciudad de Pelotas, Sur de Brasil, y dieron a luz entre septiembre de 2007 y septiembre de 2008. Las madres fueron entrevistadas en dos momentos distintos: en el período de preparto y posterior al parto. Para verificar el abuso de alcohol fue utilizada la escala Cut down, Annoyed by criticism, Guilty y Eye-opener. Se realizaron análisis bivariados y regresión logística múltiple, ajustado por las variables prematuridad y abuso de alcohol. El nivel de significancia adoptado fue de 95%. RESULTADOS: De las mujeres que participaron del estudio, 2,1% abusaron de alcohol en la gestación y, entre ellas, 26,3% tuvieron bebés con bajo peso. Hubo asociación entre el abuso de alcohol y bajo peso al nacer (pOBJETIVO: Analisar a associação entre abuso de álcool durante a gestação e baixo peso ao nascer. MÉTODOS: Estudo transversal de base populacional aninhado a uma coorte de 957 gestantes que realizaram acompanhamento pré-natal no Sistema Único de Saúde da cidade de Pelotas, RS, e deram à luz entre setembro de 2007 e setembro de 2008. As mães foram entrevistadas em dois momentos distintos: no período de pré-parto e após o parto. Para verificar o abuso do álcool foi utilizada a escala Cut down, Annoyed by criticism, Guilty and Eye-opener. Foram realizadas análises bivariadas e regressão logística múltipla, ajustada pelas variáveis prematuridade e abuso de álcool. O nível de significância adotado foi de 95%. RESULTADOS: Das mulheres que participaram do estudo, 2,1% abusaram de álcool na gestação e, entre essas, 26,3% tiveram filhos com baixo peso. Houve associação entre o abuso de álcool e baixo peso ao nascer (p < 0,038). CONCLUSÕES: Os achados indicam que o abuso de álcool durante a gestação está associado ao baixo peso ao nascer

Early motor development: risk factors for delay in a population study in Southern Brazil

OBJECTIVE: To assess risk factors associated with motor development delay at three months of age. METHODS: Cross-sectional study with mothers and their three-month-old babies in Southern Brazil. The Bayley-III Scale of Infant and Toddler Development (BSID-III) and the Alberta Infant Motor Scale (AIMS) were used to assess motor development. RESULTS: We evaluated 756 mothers and their three-month-old babies. The overall mean motor development assessed by the BSID-III and the AIMS was 104.7 (SD 13.5) and 55.4 (SD 25.4), respectively. When assessed by the BSID-III, the lowest motor development scores were among babies born by cesarean delivery (p = 0.002), prematurely (p &lt; 0.001), and with low birth weight (p &lt; 0.001). When assessed by the AIMS, babies born prematurely (p = 0.002) and with low birth weight (p=0.004) had the lowest motor development means. After a cluster analysis, we found that babies born by cesarean delivery, with low birth weight, and prematurely had more impaired motor development compared with children born without any risk factors. CONCLUSION: Identifying risk factors allows the implementation of early interventions to prevent motor development delay and, therefore, reduce the probability of other future problems

Can glutathione be a biomarker for suicide risk in women 18 months postpartum?

Background: Suicide risk is prominent among the problems affecting populations, mainly due to the broad family, psychosocial and economic impact. Most individuals at suicidal risk have some mental disorder. There is considerable evidence that psychiatric disorders are accompanied by the activation of neuro-immune and neuro-oxidative pathways. The aim of the study is to evaluate the serum levels of oxidative stress biomarkers in women at risk of suicide after 18 months of postpartum. Methods: This is a case-control study, nested within a cohort study. From this cohort, 45 women [15 without mood disorders and 30 with mood disorders (Major depression and Bipolar disorder)] were selected at 18 months postpartum, the depression and suicide risk were assessed using the MiniInternational Neuropsychiatric Interview Plus (MINI-Plus) instrument, module A and C, respectively. Blood was collected and stored for later analysis of the reactive species (DCFH), superoxide dismutase (SOD), and glutathione reduced (GSH). For data analysis, the SPSS program was used. To compare the nominal covariates with the outcome GSH levels, the Student’s t-test or analysis of variance (ANOVA) was used. Spearman’s correlation was performed for analysis between the quantitative covariates and the outcome. To analyze the interaction between the factors, multiple linear regression was performed. Bonferroni analysis was used as an additional/secondary result to visualize differences in glutathione levels according to risk severity. After the adjusted analysis, p-values < 0.05 were considered statistically significant. Results: The percentage of suicide risk observed in our sample of women at 18 months postpartum was 24.4% (n = 11). After adjusting for the independent variables, only the presence of suicide risk remained associated with the outcome (β = 0.173; p = 0.007), low levels of GSH at 18 months after postpartum. Likewise, we verified the difference in GSH levels according to the degree of suicide risk, observing a significant association between the differences in glutathione means in the group of women with moderate to high risk compared to the reference group (no suicide risk) (p = 0.009). Conclusion: Our findings suggest that GSH may be a potential biomarker or etiologic factor in women at moderate to high risk of suicide